New rapid response team easing pressure on 999 ambulances
23 January 2019
Torbay and South Devon NHS Foundation Trust is developing its in-house patient transport services in a bid to ease pressure on 999 emergency ambulances. The Trust is the only Trust in the South West to manage its own transport service rather than contracting the service out to a private company, and this gives it the opportunity to develop new initiatives that support integration across health and social care services. The service was rated as outstanding in its last CQC inspection.
One of the recent developments, overseen by Patient Transport Service Manager, Andy Knowles, is the introduction of two ‘Raizer Chairs’ to the fleet equipment list. These chairs are also used by the Trust’s community staff as a safe and effective way to help recover non-injured people who have fallen and are unable to support themselves back to a sitting or standing position. According to guidelines published by the National Institute for Health and Care Excellence (NICE), 30% of people aged 65 and over, and 50% of those aged 80 and over, are likely to fall at least once a year. So, the patient transport team has linked up with South Western Ambulance Trust, SWASFT, to provide a rapid Assisted Lifting Response Team (ALRT) service to vulnerable people and take the pressure off 999 emergency ambulance callouts.
This scheme will work in conjunction with the enhanced falls response provided by SWASFT’s award winning Community First Responder team, who also have access to Raizer Chairs.
Andy Knowles, explains: “When someone suffers a fall, it can be some time before anyone finds them and alerts the ambulance service. And, if they’re stable and uninjured, it may be several more hours before paramedics can get out to them, as they have to prioritise life-threatening emergencies. We worked with the ambulance service and other stakeholders to launch our Assisted Lifting Response Team, in a bid to provide a better service for our community and take some pressure off paramedics. For this service, someone who has fallen and alerted 999 will receive an initial triage and then a follow-up clinical triage by the ambulance service. Paramedics will then call us out to assist anyone who isn’t injured and does not require urgent hospital treatment. We can usually get to the patient in an hour, assist them back to their feet and in all cases, refer to our community staff to visit for further assessment or treatment, or to provide some home adjustments and equipment that will help prevent falls in future.”
This service is proving beneficial all round: people who have fallen and are left unsupported for a long time may suffer from a number of complications, including; hypothermia, pressure sores and breathing difficulties. By getting to them sooner, the patient is supported more quickly and able to stay in their own home, rather than being taken to hospital. In addition, paramedic crews are freed up to deal with life-threatening emergencies.
Alex Sharp, Clinical Lead (Devon) at SWASFT commented: “Patients who experience a non-injury fall are typically triaged as a Category 4 response. These are classed as less urgent calls where a response is required within three hours. Unfortunately these patients often experience long waits for assistance due to other life-threatening and serious emergencies being received and prioritised by the ambulance service.
“We have been working closely with Torbay and South Devon NHS Foundation Trust and South Devon and Torbay Clinical Commissioning Group to assist fallen patients. We are proud to have supported the introduction of the ALRT service and continue to support the service in providing the right care for the patient.
“This service will complement our own existing falls response service, which is provided by SWASFT’s award winning volunteer Community First Responders. Patients who experience a fall continue to be triaged through the 999 system. Where a non-injury fall is identified they receive an enhanced telephone triage by a paramedic or nurse in the Clinical Hub to confirm there is no injury before being passed to the ALRT service. The ALRT service response timeframe of 60 minutes is much quicker than our typical response time for a Category 4 ‘999’ call. This has wider health and social benefits for the patient who has experienced a fall, supporting them to remain at home.”
The service is increasingly in demand and is now supporting several non-injured people a week. Team manager, Andy Knowles, is already working on other developments, including, linking with other services to increase the number of non-injured fallers being supported as well as aiming to transport people referred to hospital in an emergency by their GP within 4 hours on the day, instead of having an ambulance to transport them, again freeing up paramedic crews and ambulances to deal with life – threatening injuries.